Lift with precision: Microsurgical application in maxillary sinus elevation.

[BACKGROUND] Sinus augmentation is a key procedure in implant dentistry for managing vertical bone loss in the posterior maxilla. However, conventional techniques may present limitations in precision, complication management, and ergonomics. The operating microscope has been introduced to enhance precision during procedures performed in anatomically complex maxillary sinus regions. This review aims to examine the fundamental principle, clinical application, and instrumentation of microscope-assisted sinus augmentation, with a focus on lateral and transcrestal approaches, and to evaluate current evidence in comparison to conventional methods.

[METHODS] A narrative review was conducted on studies published between 1986 and 2025 in PubMed, Web of Science, and Google Scholar, supplemented by manual reference checks. The review synthesized evidence on the application of microscope in lateral and transcrestal sinus augmentation, microsurgical instrumentation, ergonomic strategies, and piezoelectric, osteotome, and osseodensification techniques under magnification, as well as recent clinical outcomes of microscope-assisted augmentation.

[RESULTS] Microscope-assisted sinus augmentation offers distinct advantages in both lateral and transcrestal approaches. In lateral procedures, enhanced visualization enables smaller antrostomy sizes, precise lateral wall preparation, and improved membrane handling, thereby reducing the risk of perforation and postoperative complications. Transcrestal techniques may reduce patient morbidity, and lower the risk of sinus membrane perforation. Both approaches are associated with improved operator posture and ergonomic stability, contributing to greater practitioner comfort. Nevertheless, evidence remains limited, relying largely on small-scale studies with heterogeneous methodologies and short-term follow-up.

[CONCLUSION] Microscope-assisted sinus augmentation shows promising result but requires validation through randomized controlled trials with long-term outcomes to establish its clinical superiority and broader applicability.

[KEY POINTS] Microscope-assisted sinus augmentation enhances precision and safety by enabling smaller antrostomies, more accurate bone preparation, and improved membrane handling. It benefits both lateral and transcrestal approaches, reducing morbidity and the risk of perforation. Operating microscope also improves surgeon ergonomics, although long-term, high-quality evidence is still needed.

[PLAIN LANGUAGE SUMMARY] When people lose teeth in the back of the upper jaw, there often is not enough bone left to place dental implants. To fix this, a procedure called sinus augmentation is used to build-up bone in that area. Traditionally, this can be difficult due to limited visibility and a higher risk of complications. This review looked at how using an operating microscope during sinus augmentation can improve the process. The microscope gives dentists a clearer view, allowing for smaller operation area and more careful handling of the sinus membrane, which may lower the risk of tearing and other complications. It can be used with different techniques and also helps improve the dentist's working posture. Early findings suggest that microscope-assisted procedures may lead to fewer complications and better outcomes for both patients and clinicians. However, current evidence comes mostly from small studies with short follow-ups. More rigorous research is needed to confirm whether this approach is truly better than traditional methods.